RT Journal
A1 Ni H, Nauman DJ, Hershberger RE
T1 MAnaged care and outcomes of hospitalization among elderly patients with congestive heart failure
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 1998
FD June 8
VO 158
IS 11
SP 1231
OP 1236
DO 10.1001/archinte.158.11.1231
UL http://dx.doi.org/10.1001/archinte.158.11.1231
AB Background
Little was known about the impact of the health maintenance organization–managed care on patients hospitalized for congestive heart failure. Understanding this issue is important with regards to the increasing prevalence of congestive heart failure among the elderly population as well as the growing enrollment of Medicare beneficiaries in managed care.Objective
To examine the impact of the health maintenance organization–managed care on the outcomes of hospitalization among patients with congestive heart failure.Patients and Methods
We analyzed the Oregon hospital discharge data set. Study subjects were all patients with congestive heart failure aged 65 years or older (N=5821) discharged from hospitals in 1995 and classified into 6 insurance groups: managed care, Medicare, Medicaid, commercial or private insurance, self-pay, and other.Results
The percentage of patients admitted to hospitals via emergency departments was significantly higher in the managed care patients (69%) than in other health insurance coverage groups (29.0%-58.5%; P<.001). After adjusting for age, sex, and comorbidity, the managed care patients experienced a similar length of hospital stay (3.6 days) as the commercial or private insurance patients (3.7 days; P=.67), but a shorter length of hospital stay than the Medicare patients (4.0 days; P<.001), self-pay patients (4.5 days; P<.001), and other patients (4.8 days; P<.001). No difference in the in-hospital mortality rate was seen among the insurance groups (P=.37). The readmission rate was slightly higher in managed care patients (9.1%) than in commercial insurance patients (6.8%) and Medicare patients (7.5%). The differences, however, were not statistically significant after adjusting for the confounding factors (P=.59).Conclusions
Our results suggest no association between managed care and poor short-term outcomes of hospitalization in patients with congestive heart failure. Attention, however, needs to be paid to the increased use of emergency departments by managed care patients.